Provider Demographics
NPI:1053308718
Name:HANKS, MICHAEL STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:HANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1000 E PRIMROSE
Mailing Address - Street 2:STE 320
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807
Mailing Address - Country:US
Mailing Address - Phone:417-269-2300
Mailing Address - Fax:417-269-2315
Practice Address - Street 1:1000 E PRIMROSE
Practice Address - Street 2:STE 320
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-269-2300
Practice Address - Fax:417-269-2315
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOMRD1G32208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO13538OtherBLUE CROSS BLUESHIELD
E86617Medicare UPIN